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Internists are experts in complexity, and the COVID-19 pandemic is disclosing complex and unexpected interactions between communicable and non-communicable diseases, environmental factors, and socio-economic disparities. The medicine of complexity cannot be limited to facing comorbidities and to the clinical management of multifaceted diseases. Evidence indicates how climate change, pollution, demographic unbalance, and inequalities can affect the spreading and outcomes of COVID-19 in vulnerable communities. These elements cannot be neglected, and a wide view of public health aspects by a "one-health" approach is strongly and urgently recommended. According to World Health Organization, 35% of infectious diseases involving the lower respiratory tract depend on environmental factors, and infections from SARS-Cov-2 is not an exception. Furthermore, environmental pollution generates a large burden of non-communicable diseases and disabilities, increasing the individual vulnerability to COVID-19 and the chance for the resilience of large communities worldwide. In this field, the awareness of internists must increase, as privileged healthcare providers. They need to gain a comprehensive knowledge of elements characterizing COVID-19 as part of a syndemic. This is the case when pandemic events hit vulnerable populations suffering from the increasing burden of chronic diseases, disabilities, and social and economic inequalities. Mastering the interplay of such events requires a change in overall strategy, to adequately manage not only the SARS-CoV-2 infection but also the growing burden of non-communicable diseases by a "one health" approach. In this context, experts in internal medicine have the knowledge and skills to drive this change.

Record linkage of human biomonitoring (HBM) survey data with administrative register data can be used to enhance available datasets and complement the possible shortcomings of both data sources. Through record linkage, valuable information on medical history (diagnosed diseases, medication use, etc.) and follow-up information on health and vital status for established cohorts can be obtained. In this study, we investigated the availability of health registers in different EU Member States and EEA countries and assessed whether they could be linked to HBM studies. We found that the availability of administrative health registers varied substantially between European countries as well as the availability of unique personal identifiers that would facilitate record linkage. General protocols for record linkage were similar in all countries with ethical and data protections approval, informed consent, approval by administrative register owner, and linkage conducted by the register owner. Record linkage enabled cross-sectional survey data to be used as cohort study data with available follow-up and health endpoints. This can be used for extensive exposure-health effect association analysis. Our study showed that this is possible for many, but not all European countries. Record linkage of human biomonitoring (HBM) survey data with administrative register data can be used to enhance available datasets and complement the possible shortcomings of both data sources. Through record linkage, valuable information on medical history (diagnosed diseases, medication use, etc.) and follow-up information on health and vital status for established cohorts can be obtained. In this study, we investigated the availability of health registers in different EU Member States and EEA countries and assessed whether they could be linked to HBM studies. We found that the availability of administrative health registers varied substantially between European countries as well as the availability of unique personal identifiers that would facilitate record linkage. General protocols for record linkage were similar in all countries with ethical and data protections approval, informed consent, approval by administrative register owner, and linkage conducted by the register owner. Record linkage enabled cross-sectional survey data to be used as cohort study data with available follow-up and health endpoints. This can be used for extensive exposure-health effect association analysis. Our study showed that this is possible for many, but not all European countries.

Enforcement of a smoke-free policy is of vital concern in support of the health of smokers and bystanders. Indonesia has issued a smoke-free law, but implementation and enforcement lie with the regional and municipal governments. In a survey of 225 respondents recruited via schools, knowledge about the health effects of smoking and the smoke-free regulation, as well as attitudes towards and commitment and support of the enforcement of the smoke-free regulation in the Kendari City through an electronic whistleblowing system was examined. Furthermore, the participants were asked about the smoking status and smoking behavior. About half of the respondents were students (teenagers), the other half—their parents. Male respondents were strongly overrepresented (85%). Only 18% of the respondents declared to be smokers, mostly adults and males. Both the smokers and the non-smokers supported the smoke-free law and its enforcement through a whistleblowing system. Representatives of the local government were interviewed and participated in focus group discussions. In general, they also exhibited strong support of an electronic enforcement tool. However, issues of efficiency, costs, and responsibility must still be resolved. Nevertheless, an electronic whistleblowing system has the potential to further the health and livelihoods in a community like the Kendari City.

Summary A previously presented study investigated the impact of recent pesticide exposure on cytological signs of genotoxicity and on symptoms of intoxication in 71 male coffee workers in the Dominican Republic. An unexpected finding of this study was that conventional farming workers, among other symptoms, reported fewer children than controls working in organic farms without pesticide use. This study set out to investigate possible reasons for the latter difference. One statistical problem of this analysis is that the age of the workers is a strong predictor for the number of children and available data on the exposure determinants “duration of pesticide exposure” as well as “age at first pesticide exposure” are correlated with age. To correctly control statistics for these confounding parameters, different approaches to best control for age were explored. After careful elimination of the age-related confounding factors, a reduced number of children was still observed in exposed workers. The clearest effect is seen in those workers that reported first exposure before the age of 20 years. Socioeconomic factors could still confound that finding, but a direct effect of early life pesticide exposure is the most likely explanation of the observation.

The Republic of Kosovo is a small country in the Balkans. The capital city of Pristina hosts most of its population and is situated in a mountain basin with poor air exchange, especially during winter. Domestic heating, road transport, industry and coal-fired power plants contribute to high levels of air pollution. We performed a time-series analysis on effects of particulate air pollution (PM2.5) on respiratory health of children and adolescents, using hospital admission and ambulatory visit numbers from the pediatric university clinic. From 2018 until 2020, daily mean concentrations of PM2.5 ranged between 2.41 and 161.03 µg/m³. On average, there were 6.7 ambulatory visits per day with lower numbers on weekends and during the first COVID-19 wave in 2020. An increase in PM2.5 led to an immediate increase in visit numbers that lasted over several days. Averaged over a full week, this amounted to about a 1% increase per 10 µg/m³. There were, on average, 1.7 hospital admissions per day. Two and three days after a rise in air pollution, there was also a rise in admission numbers, followed by a decline during the consecutive days. This might indicate that the wards were overstressed because of high admission numbers and restricted additional admissions.

Perfluorooctane sulfonic acid (PFOS) is a ubiquitous environmental pollutant. In humans, PFOS exposure has been associated with a number of adverse health outcomes, including reduced birth weight. Whether PFOS is capable of affecting angiogenesis and thus possibly fetal development is unknown. Therefore, we investigated 1) the metabolic activity of PFOS-exposed endothelial cells (human umbilical vein endothelial cells, HUVECs), fibroblasts (normal colon fibroblasts, NCFs), and epithelial cells (human colorectal carcinoma cells, HCT116), 2) PFOS-specific inhibition of vascular endothelial growth factor receptor (VEGFR)2 stimulation in KDR/NFAT-RE HEK293 cells, and 3) the antiangiogenic potential of PFOS in a 3D in vitro angiogenesis model of HUVECs and NCFs. In terms of metabolic activity, endothelial cells (HUVECs) were much more sensitive to PFOS than fibroblasts (NCFs) or epithelial cells (HCT116). VEGFR2 signaling in KDR/NFAT-RE HEK293 cells decreased with increasing PFOS concentrations. In co-culture (angiogenesis assay), PFOS treatment resulted in a dose-dependent reduction in tip and branch formation, tip length (μm), and total structural area (μm2) with stable metabolic activity of HUVECs up to high concentrations. We conclude that PFOS possesses antiangiogenic properties. Inhibition of VEGFR2 signaling indicates a possible mechanism of action that can be linked to an existing Adverse Outcome Pathway (AOP43) containing the AO reduced birth weight. Further studies are needed to confirm PFOS-specific adverse effects on angiogenesis, placental perfusion, and fetal growth.

Conventional banana farming is pesticide-intensive and leads to high exposure of farmworkers. Ecuador is the world&rsquo, s biggest exporter of bananas. In this field study in 5 communities in Ecuador, we recorded potentially pesticide-associated subjective health symptoms in farmworkers and compared pesticide users to workers in organic farming. With one exception, symptom rates were always higher in the pesticide-exposed group. Significance was reached in 8 out of 19 investigated symptoms with the highest odds ratios (and smallest p-values) for local irritation like skin and eye irritation (OR = 3.58, CI 1.10&ndash, 11.71, and 4.10, CI 1.37&ndash, 12.31, respectively) as well as systemic symptoms like dizziness (OR = 4.80, CI 1.55&ndash, 14.87) and fatigue (OR = 4.96, CI 1.65&ndash, 14.88). Moreover, gastrointestinal symptoms were reported more frequently by pesticide users: nausea (OR = 7.5, CI 1.77&ndash, 31.77) and diarrhea (OR = 6.43, CI 1.06&ndash, 30.00). The majority of farmworkers were not adequately protected from pesticide exposure. For example, only 3 of 31 farmworkers that had used pesticides recently reported using gloves and only 6 reported using masks during active spraying. Improved safety measures and a reduction in pesticide use are necessary to protect the health of banana farmworkers.

We determined the impact of air pollution on COVID-19-related mortality and reported-case incidence, analyzing the correlation of infection case numbers and outcomes with previous-year air pollution data from the populations of 23 Viennese districts. Time at risk started in a district when the first COVID-19 case was diagnosed. High exposure levels were defined as living in a district with an average (year 2019) concentration of nitrogen dioxide (NO2) and/or particulate matter (PM10) higher than the upper quartile (30 and 20 &micro, g/m3, respectively) of all districts. The total population of the individual districts was followed until diagnosis of or death from COVID-19, or until April 21, 2020, whichever came first. Cox proportional hazard regression was performed after controlling for percentage of population aged 65 and more, percentage of foreigners and of persons with a university degree, unemployment rate, and population density. PM10 and NO2 were significantly and positively associated with the risk of a COVID-19 diagnosis (hazard ratio (HR) = 1.44 and 1.16, respectively). NO2 was also significantly associated with death from COVID-19 (HR = 1.72). Even within a single city, higher levels of air pollution are associated with an adverse impact on COVID-19 risk.

COVID-19 is an infectious disease caused by a novel coronavirus, which first appeared in China in late 2019, and reached pandemic distribution in early 2020. The first major outbreak in Europe occurred in Northern Italy where it spread to neighboring countries, notably to Austria, where skiing resorts served as a main transmission hub. Soon, the Austrian government introduced strict measures to curb the spread of the virus. Using publicly available data, we assessed the efficiency of the governmental measures. We assumed an average incubation period of one week and an average duration of infectivity of 10 days. One week after the introduction of strict measures, the increase in daily new cases was reversed, and the reproduction number dropped. The crude estimates tended to overestimate the reproduction rate in the early phase. Publicly available data provide a first estimate about the effectiveness of public health measures. However, more data are needed for an unbiased assessment.

In Europe and many countries worldwide, a half-yearly changing time scheme has been adopted with the aim of optimizing the use of natural daylight during working hours and saving energy. Because the expected net economic benefit was not achieved, the discussion about the optimal solution has been reopened with a shifted focus on social and health related consequences. We set out to produce evidence for this discussion and analysed the impact of daylight saving time on total mortality of a general population in a time series study on daily total mortality for the years 1970&ndash, 2018 in the city of Vienna, Austria. Daily deaths were modelled by Poisson regression controlling for seasonal and long-term trend, same-day and 14-day average temperature, humidity, and day of week. During the week after the spring transition a significant increase in daily total mortality of about 3% per day was observed. This was not the case during the week after the fall transition. The increase in daily mortality as observed in the week after spring DST-transition is most likely causally linked to the change in time scheme.

Substantial knowledge is available on the association of the indoor school environment and its effect among schoolchildren. In the same context, the SINPHONIE (School indoor pollution and health: Observatory network in Europe) conducted a study to collect data and determine the distribution of several indoor air pollutants (IAPs), physical and thermal parameters and their association with eye, skin, upper-, lower respiratory and systemic disorder symptoms during the previous three months. Finally, data from 115 schools in 54 European cities from 23 countries were collected and included 5175 schoolchildren using a harmonized and standardized protocol. The association between exposures and the health outcomes were examined using logistic regression models on the environmental stressors assessed in classroom while adjusting for several confounding factors; a VOC (volatile organic compound) score defined as the sum of the number of pollutants to which the children were highly exposed (concentration > median of the distribution) in classroom was also introduced to evaluate the mul tiexposu re - outcome association. Schoolchildren while adjusting for several confounding factors. Schoolchildren exposed to above or equal median concentration of PM2.5, benzene, limonene, ozone and radon were at significantly higher odds of suffering from upper, lower airways, eye and systemic disorders. Increased odds were also observed for any symptom (sick school syndrome) among schoolchildren exposed to concentrations of limonene and ozone above median values. Furthermore, the risks for upper and lower airways and systemic disorders significantly increased with the VOCs score. Results also showed that increased ventilation rate was significantly associated with decreased odds of suffering from eye and skin disorders whereas similar association was observed between temperature and upper airways symptoms. The present study provides evidence that exposure to IAPs in schools is associated with various health problems in children. Further investigations are needed to confirm our findings. (C) 2020 Elsevier B.V. All rights reserved.

Higher rates of nuclear anomalies in buccal cells of coffee workers exposed to pesticides in comparison to their unexposed peers were detected in our field study. Here, we extend our findings by examining other exposure indicators in this sample. Occupational exposure of 38 exposed and 33 non-exposed farmworkers was assessed as exposure days in the last month (0-25 days) and as years of exposure (0-47 years). Genotoxic and cytotoxic markers in buccal cells were analysed following standard procedures for buccal micronucleus cytome assay. Both exposure markers were associated with a higher frequency of nuclear anomalies with odds ratios more than 1. After restricting the analysis to the exposed workers only, this association remained only with the marker of recent exposure. In a secondary analysis also environmental exposure defined as proximity of the home to the nearest sprayed field (distance

Clinical research aiming at objectively identifying and characterizing diseases via clinical observations and biological and radiological findings is a critical initial research step when establishing objective diagnostic criteria and treatments. Failure to first define such diagnostic criteria may lead research on pathogenesis and etiology to serious confounding biases and erroneous medical interpretations. This is particularly the case for electrohypersensitivity (EHS) and more particularly for the so-called “provocation tests”, which do not investigate the causal origin of EHS but rather the EHS-associated particular environmental intolerance state with hypersensitivity to man-made electromagnetic fields (EMF). However, because those tests depend on multiple EMF-associated physical and biological parameters and have been conducted in patients without having first defined EHS objectively and/or endpoints adequately, they cannot presently be considered to be valid pathogenesis research methodologies. Consequently, the negative results obtained by these tests do not preclude a role of EMF exposure as a symptomatic trigger in EHS patients. Moreover, there is no proof that EHS symptoms or EHS itself are caused by psychosomatic or nocebo effects. This international consensus report pleads for the acknowledgement of EHS as a distinct neuropathological disorder and for its inclusion in the WHO International Classification of Diseases.

Air pollution is a threat to the general population, especially to pollen allergy sufferers in urban environments. Different air quality parameters have hitherto been examined which add to the burden of pollen allergy sufferers. Parameters such as NO

In times of rising temperatures, the question arises on how the human body adapts. When assumed that changing climate leads to adaptation, time series analysis should reveal a shift in optimal temperatures. The city of Vienna is especially affected by climate change due to its location in the Alpine Range in Middle Europe. Based on mortality data, we calculated shifts in optimal temperature for a time period of 49 years in Vienna with Poisson regression models. Results show a shift in optimal temperature, with optimal temperature increasing more than average temperature. Hence, results clearly show an adaptation process, with more adaptation to warmer than colder temperatures. Nevertheless, some age groups remain more vulnerable than others and less able to adapt. Further research focusing on vulnerable groups should be encouraged.

Panel studies are an efficient means to assess short-term effects of air pollution and other time-varying environmental exposures. Repeated examinations of volunteers allow for an in-depth analysis of physiological responses supporting the biological interpretation of environmental impacts. Twenty-four healthy students walked for 1 h at a minimum of four separate occasions under each of the following four settings: along a busy road, along a busy road wearing ear plugs, in a park, and in a park but exposed to traffic noise (65 dB) through headphones. Particle mass (PM2.5, PM1), particle number, and noise levels were measured throughout each walk. Lung function and exhaled nitrogen oxide (NO) were measured before, immediately after, 1 h after, and approximately 24 h after each walk. Blood pressure and heart rate variability were measured every 15 min during each walk. Recorded air pollution levels were found to correlate with reduced lung function. The effects were clearly significant for end-expiratory flows and remained visible up to 24 h after exposure. While immediate increases in airway resistance could be interpreted as protective (muscular) responses to particulate air pollution, the persisting effects indicate an induced inflammatory reaction. Noise levels reduced systolic blood pressure and heart rate variability. Maybe due to the small sample size, no effects were visible per specific setting (road vs. park).

Birth related complications and comorbidities are highly associated with a poor nutritional status of pregnant women, whereas iron and iodine are among especially important trace elements for healthy maternal and fetal outcomes. The study compares the status of iron, iodine, and related functional parameters in pregnant and non-pregnant women from a developing country and associates the data with pregnancy complications. The concentrations of ferritin, hemoglobin (Hb), total triiodothyronine (TT3), total thyroxine (TT4), and thyroid-stimulating hormone (TSH) were determined in the blood serum of 80 pregnant women at the time of delivery and compared with 40 non-pregnant healthy controls. Spot urine samples were taken to evaluate the urinary iodine concentration (UIC). In pregnant women, ferritin, Hb concentrations, and UIC were significantly lower, and TT4 values were significantly higher compared to controls. Higher Hb levels were tendentially associated with a reduced risk for pregnancy complications (OR = 0.747, CI (95%) 0.556&ndash, 1.004, p = 0.053). Regarding covariates, only previous miscarriages were marginally associated with pregnancy complications. High consumption of dairy products was associated with lower Hb and ferritin values. Our results suggest that pregnant women from a developing country have lower iron status with Hb levels being possibly associated with pregnancy complications.

In climbing halls, high levels of dust are found because magnesia powder is used to dry hands. Concerns have been raised about possible health effects after reports from asthmatics experiencing worsening of symptoms while or after climbing. We investigated acute and sub-acute effects of climbing in dusty halls on lung function in two pilot studies. The first study examined 109 climbers before and after a climbing activity that lasted at least 1 h. In the second study, 25 climbers from different age classes participated in a 2-day climbing competition. Of these, 24 agreed to take part in our investigation, but only 22 provided valid lung function tests on both days. The climbers underwent lung function tests before the first round of the competition (in the morning), after the second round approximately 3 h later and in the morning of the second day before the competition started again. In the first study, we found acute effects, a decline in lung function immediately after the exposure, likely due to protective reflexes of the bronchial muscles and stronger declines in persons with higher exhaled nitric oxide (NO) pre-climbing. In the second study, we also expected sub-acute effects on the next day due to inflammation. On the first day of the competition (second study), dust levels at a central monitor increased over time in a linear manner. Most of the dust was in the size range between 2.5 and 10 μm and dust levels of particulate matter (PM10) reached 0.5 mg/m3. There was a decline in lung function over 24 h in persons with higher exhaled NO levels pre-exposure. All spirometric parameters were affected though the effects were not statistically significant in all cases. Younger age classes started earlier in the morning. Because of the increasing trend in dust levels we expected stronger effects with higher numbers but for the acute effects the reverse was true, possibly because younger climbers use magnesia more or with less experience thus causing higher individual exposure. No differences by age or by time of the first climb were observed for the 24-h lung function change.

Exposure to perfluoroalkyl substances (PFAS) was found to be associated with several pathological endpoints, including high cholesterol levels, specific defective functions of the immune system and reduced birth weight. While environmental PFAS have been recognized as threats for public health, surprisingly little is known about the underlying mechanisms of toxicity. We hypothesized that some of the observed vascular and developmental effects of environmental PFAS may share a common molecular pathway. At elevated levels of exposure to PFAS, a reduction in mean birth weight of newborns has been observed in combination with a high incidence rate of preeclampsia. As both, preeclampsia and reduced birth weight are consequences of an inadequate placental vascularization, we hypothesized that the adaptation of placental vasculature may get compromised by PFAS. We analyzed pseudo-vascular network formation and protein expression in the HTR8/SVneo cell line, an embryonic trophoblast cell type that is able to form vessel-like vascular networks in 3D-matrices, similar to endothelial cells. PFOA (perfluoroctanoic acid), but not PFOS (perfuoroctanesulfonic acid), induced morphological changes in the vascular 3D-network structure, without indications of compromised cellular viability. Incubation with PFOA reduced cellular sprouting and elongated isolated stalks in pseudo-vascular networks, while a γ-secretase inhibitor BMS-906024 induced directional opposite effects. We found a PFOA-induced increase in NOTCH intracellular domain (NICD) abundance in HTR8/SVneo, indicating that PFOA enhances NOTCH-signaling in this cell type. Enhancement of NOTCH-pathway by PFOA may be a key to understand the mode of action of PFAS, as this pathway is critically involved in many confirmed physiological/toxicological symptoms associated with PFAS exposure.

Purpose To define National Diagnostic Reference Levels (NDRLs) for computed tomography (CT) for Austria on adult patients. Method In the course of a nationwide survey on common CT-examinations between June 2018 and November 2018, datasets were requested from all Austrian hospitals and radiology centers with CT-scanners. All facilities were asked to report a minimum sample of 10 representative dose length product (DLP) values per examination type and CT-scanner, including information about scan sequences, iterative reconstruction (IR) algorithms and, if available, patient data. Examination types included into the survey were the most common CT-indications for the anatomic regions head, facial bones, thorax, abdomen and pelvis. 3rd quartiles of CT-scanner median DLPs were calculated and compared to Austrian and international NDRLs. Results For 76 % of all operating CT-scanners, DLP data was submitted varying from 13 to 172 scanners per examination type. Mean year of manufacture of the CT-scanners was 2011, ranging from 2003 to 2018. In 66 % of the examinations, IR was used. 3rd quartile is on average 21 % lower for scanners using IR algorithms as opposed to scanners or protocols not using IR. In the case of gender differences, the DLP for females is on average 17 % lower than for males. Conclusions The new recommendations for CT NDRLs for Austria based on a nationwide survey are on average 13 % lower than the current Austrian NDRLs and correspond well to recent German and Swiss NDRLs. 3rd quartiles for DLP are dependent on gender, the use of IR and year of manufacture of the CT-scanners.

Banana farming represents an important segment of agricultural production in Ecuador. The health of farmworkers might be compromised by the extensive use of pesticides in plantations applied under poorly regulated conditions. Due to an increased awareness of pesticide-related problems for nature, as well as for worker and consumer health, ecological farming has been established in some plantations of Ecuador. We set out to investigate the occupational health of workers in both conventional and ecological farming. Nuclear anomalies in buccal epithelial cells were used as short-term indicators for genotoxicity and a potentially increased cancer risk in the two groups of farmworkers. By application of the Buccal Micronucleus Cytome Assay (BMCA), we found the frequency of micronuclei in conventional pesticide using farmworkers significantly increased by 2.6-fold, and other nuclear anomalies significantly increased by 24% to 80% (except pyknosis with a non-significant increase of 11%) compared to the farmworkers on ecological plantations. These results demonstrate that ecological farming may provide an alternative to extensive pesticide use with significantly reduced indicators of cancer risk. In conventional farming, improvements in education and instruction regarding the safe handling of pesticides and protective equipment, as well as regulatory measures, are urgently needed.

Objective Evaluation and updating of Austrian National Diagnostic Reference Levels (NDRLs). Methods A nationwide survey on common conventional radiography and fluoroscopy examinations was conducted. In line with Austrian radiation protection standards, all relevant Austrian hospitals and radiology offices/centers were asked to report a minimum sample of 10 representative dose-area product (DAP) values together with patient weight and fluoroscopy time, if applicable. Examinations included for conventional radiography were skull, chest, abdomen, pelvis, lumbar spine and bedside chest x-ray, for fluoroscopy barium enema (single and double contrast) and swallowing (video). Participants were invited via e-mail, followed up by reminders to increase participation rates. Plausibility checks were performed to increase data quality. 3rd quartiles of facility median and mean DAP were calculated and compared to Austrian and international NDRLs. Results 59% of invited facilities submitted DAP data, 43% submitted additional data on patient weight and 41% on fluoroscopy time. DAP case numbers varied from 1005 to 2121 for conventional radiography and from 182 to 1380 for fluoroscopy. Average patient weight was 75 kg for conventional radiography and 77 kg for fluoroscopy. Conclusion 3rd quartiles derived from the survey are substantially lower than the old Austrian NDRLs (valid till early 2018). Since 3rd quartiles correspond well to European NDRLs, the update would be in accordance with European DRL harmonisation efforts.

In the planning and authorization process of industrial plants or agricultural buildings, it needs to be ensured that odor emissions do not annoy nearby residents in an unacceptable way. Previous studies have shown that odor-hour frequency is an important predictor for odor annoyance. However, odor-hour frequencies can be assessed for day and night separately. The present study relates complaint rates with different odor types and different metrics of frequency calculated via a dispersion model. Binary logistic regression analyses show that odor type and frequency of odor-hours are important predictors for complaints, while type of residential area does not increase the predictive value of the model. The combination of calculated frequency of day time odor-hours and type of odor explains complaint rates best. It is recommended to keep odor emissions as low as possible, especially for highly annoying odor types.

Acute and sub-acute effects of pesticide use in coffee farmers have rarely been investigated. In the present field study, self-reported health symptoms from 38 male pesticide users were compared to those of 33 organic farmers. Results of cytological findings have been reported in an accompanying paper in this issue. The present second part of the study comprises a questionnaire based survey for various, potentially pesticide related symptoms among the coffee farmers. Symptom rates were generally higher in exposed workers, reaching significance in nine out of 19 assessed symptoms. Significantly increased symptom frequencies were related to neurotoxicity, parasympathic effects and acetylcholine esterase inhibition, with the highest differences found for excessive salivation, dizziness and stomach ache. We revealed a lack of precautionary measures in the majority of farmers. Better education, regulations, and safety equipment are urgently needed.

Individual skin health attitudes are influenced by various factors, including public education campaigns, mass media, family, and friends. Evidence-based, educative information materials assist communication and decision-making in doctor-patient interactions. The present study aims at assessing the prevailing use of skin health information material and sources and their impact on skin health knowledge, motives to tan, and sun protection. We conducted a questionnaire survey among a representative sample of Austrian residents. Print media and television were perceived as the two most relevant sources for skin health information, whereas the source physician was ranked third. Picking the information source physician increased participants’ skin health knowledge (p = 0.025) and sun-protective behavior (p &lt, 0.001). The study results highlight the demand for targeted health messages to attain lifestyle changes towards photo-protective habits. Providing resources that encourage pro-active counseling in every-day doctor-patient communication could increase skin health knowledge and sun-protective behavior, and thus, curb the rise in skin cancer incidence rates.

Purpose While large cotton industry plants producing for the foreign market have undergone improvements of occupational hygiene lately, working conditions in power looms producing mainly for the local market are still poor. The respiratory health in workers of power looms has not been studied so far. Methods In a cross-sectional study, 51 male cotton workers from power looms, 58 from large cotton factories and 52 controls were investigated by spirometry and a symptoms questionnaire. Spirometric measurements and respiratory symptoms were related to exposure duration in large and small factories by multivariate linear regression and logistic regression, respectively, with smoking, age and anthropometric parameters considered as confounders. Results Work duration in power looms was associated with declines in forced expiratory volume in 1 s, peak flow, maximum midexpiratory flow and forced expiratory flow 75 and an increased risk of obstruction (OR 1.09/year; 95% CI: 1.002 to 1.18) by applying the Global Lung Initiative equations. Except cough that was only associated with smoking, all respiratory symptoms (chest tightness, shortness of breath, fever) increased as a function of duration of exposure in power looms but not in large factories. Conclusions Despite limitations inherent in the cross-sectional approach, there is evidence for workers in small weaving factories to face an increased risk of pulmonary function loss and respiratory symptoms. Industrial hygiene measures in these small enterprises should be encouraged. Failure to detect adverse respiratory outcomes from occupation in large factories could be due to a ‘survivor’ (healthy worker) effect.

Based on a pooled analysis of data from an international study, evaluate total and cause-specific mortality among hardmetal production workers with emphasis on lung cancer.Study members were 32,354 workers from three companies and 17 manufacturing sites in five countries. We computed standardized mortality ratios and evaluated exposure-response via relative risk regression analysis.Among long-term workers, we observed overall deficits or slight excesses in deaths for total mortality, all cancers, and lung cancer and found no evidence of any exposure-response relationships for lung cancer.We found no evidence that duration, average intensity, or cumulative exposure to tungsten, cobalt, or nickel, at levels experienced by the workers examined, increases lung cancer mortality risks. We also found no evidence that work in these facilities increased mortality risks from any other causes of death.

OBJECTIVE This study retrospectively investigates causes of death among workers of a hardmetal plant in Austria. METHODS A retrospective cohort was formed of 1965 workers still employed in or after 1970. Follow-up was until end of 2014 based on national databases. Cobalt exposure was assessed through industrial hygiene data and urine analyses. Cox proportional hazards models were calculated for selected causes of death. RESULTS During 45,598 years of observation in total 177 deaths were observed. Forty-nine workers died from any cancer, 10 from lung cancer, and three from chronic obstructive pulmonary disease. Only the latter showed a significant association with cumulative exposure. CONCLUSIONS Although this is a young study population with little power to detect subtle effects, at least it does not indicate a pronounced cancer risk among tungsten carbide workers due to cobalt.

Connectedness to nature (CN) influences motivation to have contact with outdoor natural environments. Spending leisure time in natural environments is beneficial for human health and well-being. Besides these positive effects, health risks of open-air activities are mainly related to unprotected sun light exposure-associated acute and chronic skin hazards. Thus, we conducted a cross-sectional, representative telephone survey among Austrian residents to study the association of perceived CN level with sun-exposure knowledge, tanning habits, and sun protective behaviour. In total, 1,500 study subjects (50.5% females) participated in this questionnaire survey. Although knowledge about tanning and motives to tan were similar among genders, females performed more photoprotective measures and were more connected to nature (all p < 0.001) compared to males. Older age and outdoor sport were significant gender-independent predictor variables influencing perceived CN level. Additionally, level of education was relevant in male CN, whereas non-smoking and higher knowledge were predictive of female CN. This survey provides so far unreported empirical data on the relationship between nature connectedness and skin health-relevant recreational habits of Austrian residents. The findings suggest to integrate hitherto neglected gender-specific Public (Skin) Health promotion when counselling on the manifold health advantages of outdoor activities.

In a cross-sectional study on 433 schoolchildren (aged 6&ndash, 9 years) from 9 schools in Austria, we observed associations between housing factors like passive smoking and lung function as well as improved lung function in children who had been breast-fed. The latter findings urged the question of whether the protective effects of breast-feeding act on environmental stressors or if they act independently. Therefore, the effect of passive smoking on lung function was stratified by breast-feeding. The detrimental effects of passive smoking were significant but restricted to the group of 53 children without breast-feeding. Breast-feeding counteracts the effect of environmental stressors on the growing respiratory organs.

Adverse health effects of work-related contact with respirable hazardous substances are of great public interest. Because related prospective and long-term follow-up studies are rare, the extent of acute and chronic pulmonary health risks of occupational exposure to welding fumes is discussed controversially in the scientific literature. The objective of the present longitudinal study during a 9-year period was to investigate the annual changes of lung function in welders. Anthropometric measures and smoking behaviour, and spirometric tests (FVC, FEV1, and MEF50) obtained during routine occupational health checkups of female and male workers (n = 1,982) in Austria during the years 2002–2010 were analyzed. The study participants displayed average lung function values lower than the age- and sex-specific norm. Decrease in respiratory capacity was dependent on smoking habits and duration of occupational exposure. Specifically for welders (n = 1,326), decrease of pulmonary function was significantly associated with heavy smoking (FVC −70.7 ml, p = 0.07; FEV1 −167.4 ml, p

Objectives: WHO's Children's Environment and Health Action Plan for Europe (CEHAPE) focuses on improvements of indoor environments where children spend most of their time. To investigate the relationship between school indoor air pollutants and cognitive performance in elementary school children, a multidisciplinary study was planned in all-day schools in Austria. Materials and Methods: In a cross-sectional study (LuKi study: Air and Children) indoor air pollutants were monitored in nine elementary all-day schools in urban and rural regions of Austria. In addition, school dust and suspended particulates (PM10, PM2.5) were measured, focusing on semivolatile compounds (e.g. phthalates, phosphororganic compounds [POC]). Health status and environmental conditions were determined by parents' questionnaire, cognitive function was measured by Standard Progressive Matrices (SPM). Results: Overall, 596 children (6-8 years of age) were eligible for the study. Cognitive tests were performed in 436 children. Analysis showed significant correlations of tris(2-chlorethyl)-phosphate (TCEP) in PM10 and PM2.5 and school dust samples with cognitive performance. Cognitive performance decreased with increasing concentrations of TCEP. Furthermore, cognitive function decreased significantly with increasing CO2 levels. Conclusions: POC are widely used as plasticizers, flame retardants and floor sealing. This is the first report of a correlation between TCEP in indoor air samples and impairment of cognitive performance in school children. As a precautionary measure, it is recommended to prohibit the use of toxic chemicals and those suspected of a toxic potential in children's environments such as schools.

Levoglucosan is a sugar anhydride produced by combustion of carbohydrates. In ambient monitoring it serves as an indicator for wood smoke. Its use in human biomonitoring, however, is not yet widespread. This study investigated whether levoglucosan in urine is a suitable biomarker for regional differences in wood smoke exposure in the winter season. Within the first Austrian biomonitoring survey, pooled urine samples from mothers as well as children of five communities of different size (two-stage random stratified sampling) were analysed by HPLC. As an indicator of exposure to polycyclic aromatic hydrocarbons (PAH) that are also prevalent in wood smoke, 1-hydroxypyrene was determined. In each town levoglucosan was found in higher levels in the pooled children's samples than in the pooled mothers’ samples. It correlated well with the agrarian quota. 1-Hydroxypyrene concentrations were higher in areas with higher population density. Correlation of urinary levoglucosan concentrations with the agrarian quota may be explained by higher wood smoke exposure in communities with higher agrarian quota. To our knowledge this study is the first investigation on this issue in Europe. It indicates that human biomonitoring of levoglucosan may be suitable to detect differences in regional exposure to wood smoke.

Fine particles in hospitality venues with insufficient smoking bans indicate health risks from passive smoking. In a random sample of Viennese inns (restaurants, cafes, bars, pubs and discotheques) effects of partial smoking bans on indoor air quality were examined by measurement of count, size and chargeable surface of ultrafine particles (UFPs) sized 10-300 nm, simultaneously with mass of particles sized 300-2500 nm (PM2.5). Air samples were taken in 134 rooms unannounced during busy hours and analyzed by a diffusion size classifier and an optical particle counter. Highest number concentrations of particles were found in smoking venues and smoking rooms (median 66,011 pt/cm(3)). Even non-smoking rooms adjacent to smoking rooms were highly contaminated (median 25,973 pt/cm(3)), compared with non-smoking venues (median 7408 pt/cm(3)). The particle number concentration was significantly correlated with the fine particle mass (P0.001). We conclude that the existing tobacco law in Austria is ineffective to protect customers in non-smoking rooms of hospitality premises. Health protection of non-smoking guests and employees from risky UFP concentration is insufficient, even in rooms labeled "non-smoking". Partial smoking bans with separation of smoking rooms failed.

Ultra-Violet (UV) radiation covers the spectrum of wavelengths from 100 to 400 nm. The potency and biological activity for a variety of endpoints differ by wavelength. For monitoring and communication purposes, different UV action spectra have been developed. These spectra use different weighting functions. The action spectrum for erythemal dose is the most widely used one. This erythemal dose per time or dose-rate has been further simplified into a “UV index”. Following this example, in our review we use the term “index” or (plural) “indices” in a more general description for all simplified single-value measures for any biologically effective UV dose, e.g., for human non-melanoma skin cancer and for previtamin D production rate. Ongoing discussion about the existence of an increased melanoma risk due to UV-A exposure underscores the uncertainties inherent in current weighting functions. Thus, we performed an online literature search to review the data basis for these indices, to understand their relevance for an individual, and to assess the applicability of the indices for a range of exposure scenarios. Even for natural (solar) UV, the spectral composition varies spatially and temporally. Artificial UV sources and personal protection introduce further variation to the spectral composition. Many biological effects are proposed for UV radiation. Only few endpoints have been studied sufficiently to estimate a reliable index. Weighting functions for chronic effects and most importantly for cancer endpoints have been developed in animal models, and often for proxy endpoints only. Epidemiological studies on biological effects of UV radiation should not only depend on single-value weighted UV dose estimates (indexes) but should strive for a more detailed description of the individual exposure. A better understanding of the adverse and beneficial effects of UV radiation by wavelength would also improve medical counseling and health communication regarding individual health-supportive behavior.

Recreational sunbed use accounts for the main non-solar source of exposure to ultraviolet radiation in fair-skinned Western populations. Indoor tanning is associated with increased risks for acute and chronic dermatological diseases. The current community-based study assessed the one-year prevalence of sunbed use and associated skin health habits among a representative, gender-balanced sample of 1500 Austrian citizens. Overall one-year prevalence of sunbed use was 8.9% (95% confidence interval (CI) 7.5%–10.4%), with slightly higher prevalence in females (9.2%, 95% CI 7.3%–11.2%) compared to males (8.6%, 95% CI 6.7%–10.6%). Factors predicting sunbed use were younger age (by trend decreasing with older age), place of living, smoking, skin type (by trend increasing with darker skin), sun exposure, motives to tan, and use of UV-free tanning products. Despite media campaigns on the harmful effects of excessive sunlight and sunbed exposure, we found a high prevalence of self-reported sunbed use among Austrian citizens. From a Public (Skin) Health perspective, the current research extends the understanding of prevailing leisure time skin health habits in adding data on prevalence of sunbed use in the general Austrian population.

Recreational sun exposure accounts for a large number of acute and chronic dermatological diseases, including skin cancer. This study aimed at estimating the one-year prevalence of sun exposure and skin health-associated knowledge and attitudes among Austrian citizens. The population-based UVSkinRisk survey investigated a representative sample of Austrian adults using a structured questionnaire. In total, 1500 study subjects (median age 33.0 years, 50.5% females) participated in this questionnaire survey. Among study participants, prevalence of sun exposure was 47%, with slightly higher rates in males (48%) compared to females (46%). Younger age, lower professional category, darker skin type, motives to tan, sunbed use, sunburn, and outdoor sport activity increased the odds for prevalent sun exposure. This is the first population-based study evaluating the prevailing sun exposure and recreational habits influencing skin health among Austrian citizens. Despite public media campaigns educating on the harmful effects of sunlight exposure, we found a high prevalence of self-reported sunlight exposure. The results suggest that multifaceted socio-cultural characteristics stimulate recreational sun exposure and tanning habits. Communicating individualized Public (Skin) Health messages might be the key to prevent photo-induced skin health hazards in light-skinned populations. The practical and theoretical implications of these findings are discussed.

Chronic diseases and illnesses associated with non-specific symptoms are on the rise. In addition to chronic stress in social and work environments, physical and chemical exposures at home, at work, and during leisure activities are causal or contributing environmental stressors that deserve attention by the general practitioner as well as by all other members of the health care community. It seems necessary now to take “new exposures” like electromagnetic fields (EMF) into account. Physicians are increasingly confronted with health problems from unidentified causes. Studies, empirical observations, and patient reports clearly indicate interactions between EMF exposure and health problems. Individual susceptibility and environmental factors are frequently neglected. New wireless technologies and applications have been introduced without any certainty about their health effects, raising new challenges for medicine and society. For instance, the issue of so-called non-thermal effects and potential long-term effects of low-dose exposure were scarcely investigated prior to the introduction of these technologies. Common electromagnetic field or EMF sources: Radio-frequency radiation (RF) (3 MHz to 300 GHz) is emitted from radio and TV broadcast antennas, Wi-Fi access points, routers, and clients (e.g. smartphones, tablets), cordless and mobile phones including their base stations, and Bluetooth devices. Extremely low frequency electric (ELF EF) and magnetic fields (ELF MF) (3 Hz to 3 kHz) are emitted from electrical wiring, lamps, and appliances. Very low frequency electric (VLF EF) and magnetic fields (VLF MF) (3 kHz to 3 MHz) are emitted, due to harmonic voltage and current distortions, from electrical wiring, lamps (e.g. compact fluorescent lamps), and electronic devices. On the one hand, there is strong evidence that long-term exposure to certain EMFs is a risk factor for diseases such as certain cancers, Alzheimer’s disease, and male infertility. On the other hand, the emerging electromagnetic hypersensitivity (EHS) is more and more recognized by health authorities, disability administrators and case workers, politicians, as well as courts of law. We recommend treating EHS clinically as part of the group of chronic multisystem illnesses (CMI), but still recognizing that the underlying cause remains the environment. In the beginning, EHS symptoms occur only occasionally, but over time they may increase in frequency and severity. Common EHS symptoms include headaches, concentration difficulties, sleep problems, depression, a lack of energy, fatigue, and flu-like symptoms. A comprehensive medical history, which should include all symptoms and their occurrences in spatial and temporal terms and in the context of EMF exposures, is the key to making the diagnosis. The EMF exposure is usually assessed by EMF measurements at home and at work. Certain types of EMF exposure can be assessed by asking about common EMF sources. It is very important to take the individual susceptibility into account. The primary method of treatment should mainly focus on the prevention or reduction of EMF exposure, that is, reducing or eliminating all sources of high EMF exposure at home and at the workplace. The reduction of EMF exposure should also be extended to public spaces such as schools, hospitals, public transport, and libraries to enable persons with EHS an unhindered use (accessibility measure). If a detrimental EMF exposure is reduced sufficiently, the body has a chance to recover and EHS symptoms will be reduced or even disappear. Many examples have shown that such measures can prove effective. To increase the effectiveness of the treatment, the broad range of other environmental factors that contribute to the total body burden should also be addressed. Anything that supports homeostasis will increase a person’s resilience against disease and thus against the adverse effects of EMF exposure. There is increasing evidence that EMF exposure has a major impact on the oxidative and nitrosative regulation capacity in affected individuals. This concept also may explain why the level of susceptibility to EMF can change and why the range of symptoms reported in the context of EMF exposures is so large. Based on our current understanding, a treatment approach that minimizes the adverse effects of peroxynitrite – as has been increasingly used in the treatment of multisystem illnesses – works best. This EMF Guideline gives an overview of the current knowledge regarding EMF-related health risks and provides recommendations for the diagnosis, treatment and accessibility measures of EHS to improve and restore individual health outcomes as well as for the development of strategies for prevention.

The dependency on carbon-based fossil energy and growing awareness of climate change issues has induced ambitious policy initiatives to promote renewable energy sources for indoor heating. Combustion of regionally available material such as wood is considered a carbon-neutral alternative for oil and gas, but unregulated revival of wood stoves may cause detrimental health effects. For the prognosis of the health impact of air pollution due to the use of wood stoves, Upper Austria served for a case study. On the basis of recent measurements of particulate matter10 μm in aerodynamic diameter (PM10) and nitrous gases (NO(x)), we compared the air pollution attributable to present energy mix (termed scenario 1) with two alternatives: For scenario 2, we assumed replacement of light fuel oil by either fossil gas or biomass, and for scenario 3, replacement of light fuel oil by biomass only. Compared with the current exposure from scenario 1, the increased annual mean PM10 levels are estimated to lead to 101 (95% CI 56;146) and 174 (95% CI 92;257) additional deaths among 1.4 million inhabitants per year for scenarios 2 and 3, respectively. Without adequate strategies for reducing the emissions of domestic heating facilities, replacement of fossil energy sources could lead to an increased health risk.

Humans are exposed to a broad variety of man-made chemicals. Human biomonitoring (HBM) data reveal the individual body burden irrespective of sources and routes of uptake. A first population-based study was started in Austria in 2008 and was finished at the end of May 2011. This cross sectional study aims at documenting the extent, the distribution and the determinants of human exposure to industrial chemicals as well as proving the feasibility of a representative HBM study. Overall, 150 volunteers (50 families) were selected by stratified random sampling. Exposure to phthalates, trisphosphates, polybrominated diphenyl ethers (PBDE), bisphenol A (along with nonyl- and octyl phenol) and methyl mercury was assessed. Sixteen of 18 PBDE determined were detected above the limit of quantification (LOQ) in blood samples with #153 and #197 the most abundant species. Bisphenol A in urine was measured in a subsample of 25 with only 4 samples found above the LOQ. In 3 of 100 urine samples at least one of 8 trisphosphate compounds assessed was above the LOQ. These first analytical results of the human biomonitoring data show that the body burden of the Austrian population with respect to the assessed compounds is comparable to or even lower than in other European countries. Overall, the study revealed that in order to develop a feasible protocol for representative human biomonitoring studies procedures have to be optimized to allow for non-invasive sampling of body tissues in accordance with the main metabolic pathways. Procedures of participants’ recruitment were, however, labor intensive and have to be improved.

Intensive agrochemical use in coffee production in the Global South has been documented. The aim of this study was to investigate cytotoxic and genotoxic effects of pesticide exposure in male farmworkers in the Dominican Republic comparing conventional farming using pesticides to organic farming. Furthermore, feasibility of the buccal micronucleus cytome assay (BMCA) for field studies under difficult local conditions was tested. In a cross-sectional field study, pesticide exposed (sprayers) and non-exposed male workers on coffee plantations were interviewed about exposure history, and pesticide application practices. Buccal cells were sampled, and BMCA was applied to assess potential effects on cell integrity. In total, 38 pesticide-exposed and 33 non-exposed workers participated. Eighty-four and 87%, respectively, of the pesticide-exposed respondents did not use masks or gloves at all. All biomarkers from the BMCA were significantly more frequent among exposed workers&mdash, odds ratio for micronucleated cells: 3.1 (95% confidence interval: 1.3&ndash, 7.4) or karyolysis: 1.3 (1.1&ndash, 1.5). Buccal cells as sensitive markers of toxic oral or respiratory exposures proved feasible for challenging field studies. Our findings indicate that the impact of pesticide use is not restricted to acute effects on health and wellbeing, but also points to long-term health risks. Therefore, occupational safety measures including training and protective clothing are needed, as well as encouragement towards minimal application of pesticides and more widespread use of organic farming.

In response to the World Health Organization Children's Environment and Health Action Plan for Europe (CEHAPE), a town near Vienna initiated a health survey of schoolchildren. To create recommendations for the community's decision makers, the health survey tried to identify the environmental factors influencing the respiratory health of children. The survey consisted of a questionnaire and spirometry. For 186 of 207 children of first and second grade, parents consented to include their children and answered a questionnaire. Spirometry was performed in 177 children. Results of lung function testing revealed that lung function was significantly reduced in children with visible mould infestation at home and living on a street with frequent lorry traffic. Larger family size and living in a rural area had positive effects on lung function. Our study provides an example for a feasible strategy to provide local decision makers with recommendations based on scientific evidence and actual observations and to help them implement measures in accordance with CEHAPE.

BACKGROUND: Living in a damp or mouldy home reportedly damages children's respiratory health, yet mould appears not to be a prominent risk factor in the public's perception. Analyses of data on over 58,000 children from the Pollution and the Young (PATY) study are presented. In this collaboration, researchers from 12 cross-sectional studies pooled their data to assess the effects of air quality on a spectrum of children's respiratory disorders. METHOD: Original studies were conducted in Russia, North America and 10 countries in Eastern and Western Europe. Pooled analyses were restricted to children aged 6-12 years. Associations between visible mould reported in the household and a spectrum of eight respiratory and allergic symptoms were estimated within each study. Logistic regressions were used, controlling for individual risk factors and for study area. Heterogeneity between study-specific results and mean effects (allowing for heterogeneity) were estimated using meta-analysis. RESULTS: Visible mould was reported by 13.9% of respondents in Russia, increasing to 39.1% in North America. Positive associations between exposure to mould and children's respiratory health were seen with considerable consistency across studies and across outcomes. Confounder-adjusted combined ORs ranged from 1.30 (95% CI 1.22 to 1.39) for "nocturnal cough" to 1.50 (1.31 to 1.73) for "morning cough". Evidence of stronger effects in more crowded households was statistically significant for only asthma and sensitivity to inhaled allergens. No consistent interactions between mould and age, sex or parental smoking were found. CONCLUSION: Indoor mould exposure was consistently associated with adverse respiratory health outcomes in children living in these diverse countries.

The objective of this longitudinal (3 year) study was to determine predictors of abstinence in 515 employees of a steel plant (28% female, age 18-67 years) after participation in Allen Carr seminars (intensive group counselling in a single session of 6 h). Answers given in computer aided phone interviews were analysed by stepwise and Cox regression. Of 510 responding persons 262 (51.4%) reported continuing abstinence. In a random sample of 61 respondents cotinine concentration in urine was measured, showing high agreement with smoking history. Social support increased abstinence, which was more persistent in males and office workers. Also in female participants the non-smoking spouse was a significant predictor for abstinence while a higher body weight predicted relapse. Relapsed female smokers did not show a sustainable reduction of cigarette consumption. Compared to cessation clinics higher population coverage would be achievable by workplace seminars. Every second smoker motivated to participate seems to be able to quit even without medication and to stay abstinent. Especially in females these seminars should be followed by physical exercise and continued support of gender specific occupational health care.

PURPOSE Lifetime risk for melanoma skin cancer is enlarged by sunlight exposure and reduced by sun protection. Austrian melanoma incidence and mortality rates are constantly rising with higher rates in males. Thus, we aimed at investigating gender-specific recreational sun exposure habits among the Austrian population. METHODS We conducted a telephone survey among 1500 adults (50.5% females) representing sociodemographic characteristics of the Austrian population. Using a structured questionnaire, we studied gender-specific sun exposure-related knowledge, motives to tan, and behavior. RESULTS Overall, using sunscreen, wearing sunglasses, and seeking shade were among the three most frequent sun safe measures. Basic skin health knowledge and tanning motives were similar among genders, although females protected themselves more. In general, sunburn occurrence (odds ratio [OR] = 1.4, 95% confidence interval [CI] = 1.0-1.8), skin type IV (OR = 2.4, 95% CI = 1.3-4.5), ex-/non-smoking (OR = 1.4-1.6, 95% CI = 1.0-2.1), low motives to tan (both OR = 1.3, 95% CI = 1.0-1.7), no outdoor sport (OR = 1.3, 95% CI = 1.0-1.7), all P < 0.05, as well as the use of sunscreen with lower SPF values (OR = 1.0-3.0, 95% CI = 1.4-4.3) and male gender (OR = 1.6, 95% CI = 1.2-2.0), both P < 0.001, increased the odds of practicing low sun protection. CONCLUSION The results of this investigation suggest considering gender specificity when planning Public (Skin) Health-related educative campaigns and programs, for example, by highlighting the appearance-related benefits of sun light avoidance.

Background: The EU strategy for the Danube Region addresses numerous challenges including environment, health and socioeconomic disparities. Many old environmental burdens and heavily polluted areas in Europe are located in the Danube Region, consisting of 14 countries, with over 100 million people. Estimating the burden of environmental exposures on early-life health is a growing research area in Europe which has major public health implications, but the data from the Danube Region are largely missing. Aim: This review presents an inventory of current environmental challenges, related early-life health risks, and knowledge gaps in the Danube Region, based on publicly available databases, registers, and literature, as a rationale and incentive for a new integrated project. The review also proposes the concept for the project aiming to characterize in utero exposures to multiple environmental factors and estimate their effect on early-life health, evaluate economic impact, as well as identify interventions with a potential to harness social norms to reduce emissions, exposures and health risks in the Danube Region. Methods: Experts in environmental epidemiology, human biomonitoring and social science in collaboration with clinicians propose to establish a new large multi-center birth cohort of mother-child pairs from Danube countries, measure biomarkers of exposure and health in biological samples at birth, collect centrally measured climate, air and water pollution data, conduct pre- and postnatal surveys on lifestyle, indoor exposures, noise, occupation, socio-economic status, risk-averting behavior, and preferences; and undertake clinical examinations of children at and after birth. Birth cohort will include at least 2000 newborns per site, and a subset of at least 200 mother-child pairs per site for biomonitoring. Novel biomarkers of exposure, susceptibility, and effect will be applied, to gain better mechanistic insight. Effects of multiple environmental exposures on fetal and child growth, respiratory, allergic, immunologic, and neurodevelopmental health outcomes will be estimated. Parent's willingness to pay for reducing health risks in children will be elicited by survey, while values of cost-of-illness will be gathered from literature and national statistics. Effects of risk reducing interventions will be examined. Conclusions: The proposed project would provide novel estimates of the burden of early childhood diseases attributable to environmental exposures and assess health impacts of different intervention scenarios in the Danube Region, in an integrated approach combining human biomonitoring, epidemiological and social science research. Keywords: Birth cohort, Environment, Biomonitoring, Air pollution, Danube region, Childhood health

Cotton workers in small weaving household factories (power looms) in Pakistan are typically exposed to high levels of cotton dusts. Working in the textile manufacturing industry has been classified as a possible human carcinogen (group 2B) by the International Agency for Research on Cancer. The study set out to determine potential cytotoxic and genotoxic effects of occupational exposure to cotton dusts in exfoliated buccal cells of exposed cotton workers. Nuclear anomalies reflecting cytotoxic and genotoxic effects were evaluated in a representative sample of 51 exposed male cotton weavers and in the same number of age-matched male non-exposed subjects applying the micronucleus cytome assay. Nuclear anomalies reflecting cytotoxicity (karyolysis, karyorrhexis, condensed chromatin and pyknosis) were significantly elevated in exposed cotton workers. The frequency of micronucleated cells increased significantly with increasing years of work in power looms (odds ratio = 1.043 per year; 95% confidence interval: 1.012–1.076, P = 0.007). Results were consistent with the typical inflammatory pattern and injury in epithelia due to unprotected occupational exposure to cotton dusts and other toxic, allergic and infectious substances in the working areas of the cotton industry. Occupational exposure in power looms induces cytotoxic effects and, upon chronic exposure, DNA damage. This may eventually result in typical obstructive patterns of pulmonary symptoms and in a clinical condition called byssinosis in exposed cotton workers. Long exposure may lead to chronic inflammation and cumulative damage of DNA in buccal stem cells that may indicate an increased risk of oropharyngeal cancer.

Both prenatal and postnatal passive smoking have been linked with respiratory symptoms and asthma in childhood. Their differential contributions to lung function growth in the general children's population are less clear.To study the relative impact of pre- and postnatal exposure on respiratory functions of primary school children in a wide range of geographic settings, we analyzed flow and volume data of more than 20,000 children (aged 6-12 yr) from nine countries in Europe and North America.Exposure information had been obtained by comparable questionnaires, and spirometry followed a protocol of the American Thoracic Society/European Respiratory Society. Linear and logistic regressions were used, controlling for individual risk factors and study area. Heterogeneity between study-specific results and mean effects were estimated using meta-analytic tools.Smoking during pregnancy was associated with decreases in lung function parameters between -1% (FEV1) and -6% maximal expiratory flow at 25% of vital capacity left (MEF25). A 4% lower maximal midexpiratory flow (MMEF) corresponded to a 40% increase in the risk of poor lung function (MMEF75% of expected). Associations with current passive smoking were weaker though still measurable, with effects ranging from -0.5% (FEV1) to -2% maximal expiratory flow (MEF50).Considering the high number of children exposed to maternal smoking in utero and the even higher number exposed to passive smoking after birth, this risk factor for reduced lung function growth remains a serious pediatric and public health issue.